▲Professor Jonggi Choi and Specialist Hyeyeon Hong

Patients with chronic hepatitis B take antiviral agents such as tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) to suppress viral replication. While concerns have been raised about the prolonged use of TAF potentially increasing the risk of cardiovascular diseases, recent research by a team of Professor Jonggi Choi and Specialist Hyeyeon Hong of the Division of Gastroenterology at Asan Medical Center found no difference in cardiovascular disease incidence between TDF and TAF users.

TAF is an antiviral agent that reduces the side effects of osteoporosis and renal function impairment associated with TDF, providing the same therapeutic effect at 10% of TDF’s dosage. However, TAF has raised concerns about the possible occurrence of cardiovascular diseases because it does not decrease lipid parameters, unlike TDF, which reduces all lipid parameters, including total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol.

The research team studied 4,124 patients with chronic hepatitis B from 2021 to 2022, dividing them into 3,186 patients on TDF and 938 patients on TAF to follow up on the cumulative incidence of cardiovascular diseases. During the observation period of 15,527 person-years (1 person-year is a 1-year observation on 1 patient), the number of cardiovascular disease occurrences was 37 in TDF users and 5 in TAF users. The cumulative incidence rates in TDF users at 1 year, 3 years, and 5 years were 0.4%, 0.8%, and 1.2% respectively. This was comparable to 0.2%, 0.7%, and 0.7% in TAF users, with no statistically significant differences.

Notably, no difference was found in propensity score matching analysis where differing characteristics of underlying diseases between the two groups are adjusted for. There were also no significant differences in the total cholesterol to HDL ratio, which is known to be associated with the risk of cardiovascular diseases.

The research findings were recently published in the ‘Clinical and Molecular Hepatology.’